Diseases of the Blood - White blood cell diseases
For every 600 to 700 or more red corpuscles, there is one white blood cell, or leukocyte . White cells, unlike red corpuscles, have nuclei; they are also larger and rounder. About 70 percent of the white cell population have irregularly-shaped centers, and these are called polymorphonuclear leukocytes or neutrophils . The other 30 percent are made up of a variety of cells with round nuclei called lymphocytes . A cubic millimeter of blood normally contains anywhere from 5,000 to 9,000 white cells (as compared with the four to five million red cells).
White cells defend against disease, which explains why their number increases in the bloodstream when the body is under infectious assault. There are some diseases of the blood and blood-forming organs themselves that can increase the white count. Disorders of the spleen, for example, can produce white cell abnormalities, because this organ is a major source of lymphocytes (cells responsible for making protective antibodies). Diseases of the bone marrow are likely to affect neutrophil production.
Leukemia, characterized by an abnormal increase in the number of white cells, is one of the most dangerous of blood disorders. The cancerlike disease results from a severe disturbance in the functioning of the bone marrow. Chronic leukemia, which strikes mainly in middle age, produces an enormous increase in neutrophils, which tend to rush into the bloodstream at every stage of their development, whether mature or not. Patients with the chronic disease may survive for several years, with appropriate treatment.
In acute leukemia, more common among children than adults, the marrow produces monster-sized, cancerous-looking white cells. These cells not only crowd out other blood components from the circulation, they also leave little space for the marrow to produce the other elements, especially the red cells and platelets. Acute leukemias run their fatal course in a matter of weeks or months—although there have been dramatic instances of sudden remission. The cause is unknown, but recent evidence strongly suggests that a virus may be responsible for at least some forms of the disease.
Modern treatment—radiation and drugs—is aimed at wiping out all of the malignant cells. A critical stage follows treatment, however. For with the disappearance of these abnormal cells and the temporary disruption of marrow function, the patient is left with his defenses against infection down. He also runs a great risk of hemorrhage. Therefore, he is usually kept in isolation to ward off infections. In addition he may be given white cell and platelet transfusions along with antibiotic therapy. Eventually—and hopefully—the marrow will revert to normal function, freed of leukemic cell production. For additional information on leukemia, see Ch. 18, Cancer .
Other White Cell Diseases
Agranulocytosis is a disease brought on by the direct destruction of neutrophils (also called granulocytes ). Taken over a long period of time, certain types of drugs may bring about large-scale destruction of the neutrophil supply. Symptoms include general debilitation, fatigue, sleeplessness, restlessness, headache, chills, high fever (often up to 105° F.), sore mouth and throat, along with psychologically aberrant behavior and mental confusion. White cell count may fall as low as 500 to 2,000. Sometimes agranulocytosis is confused with leukemia.
Treatment involves antibiotic therapy to ward off bacterial invasion, a likelihood that is increased owing to the lowered body resistance. In advanced cases, hospitalization and transfusions with fresh blood are necessary. Injections of fresh bone marrow may also be prescribed.
Leukopenia is less severe than agranulocytosis. It too involves a reduction of circulating white cells to counts of less than 5,000. It is usually the result of allergic reactions to some chemical or drug.
Infectious mononucleosis, also known as glandular fever or kissing disease , is characterized by the presence in the bloodstream of a large number of lymphocytes, many of which are abnormally formed. The disease is mildly contagious—kissing is thought to be one popular source of transmission—and occurs chiefly among children and adolescents. The transmitting agent, however, has yet to be discovered, though some as yet unidentified organism is strongly suspected.
The disease is not always easy to diagnose. It can incubate anywhere from four days to four weeks, at which point the patient may experience fever, headache, sore throat, swollen lymph nodes, loss of appetite, and a general feeling of weakness.
The disease runs its course in a matter of a week or two, although complete recovery may take a while longer. Bed rest and conservative medical management is often enough for complete patient recovery. A few severe cases may require hospitalization because of occasional complications, such as rupture of the spleen, skin lesions, some minor liver malfunctions, and occasionally hemolytic anemia or purpura.